Clinical Research Directory

Inclusion Criteria Systemically healthy male and female individuals aged between 18 and 50 years No physical or mental disabilities No underlying systemic diseases Mandibular permanent premolar teeth diagnosed with symptomatic irreversible pulpitis with apical periodontitis Mandibular permanent premolar teeth diagnosed with symptomatic irreversible pulpitis without apical periodontitis Diagnosis based on the terminology of the American Association of Endodontists (2009) Patients who provided written informed consent Fully developed teeth with no previous pulp exposure Positive response to cold testing Positive response to electric pulp testing Exclusion Criteria Requirement for antibiotic prophylaxis Diabetes or hematologic disorders Use of anti-inflammatory drugs, antibiotics, or antidepressants within the previous four weeks Pregnancy at the time of treatment Heavy plaque or calculus accumulation Gingival redness and bleeding Severe gingivitis or generalized periodontitis Gingival pocket depths greater than 3 mm Negative response to sensibility testing (cold test or electric pulp testing) Presence of apical radiolucency (PAI \> 2) Previously initiated endodontic treatment Internal or external root resorption History of trauma Severe calcific metamorphosis with obliterated root canal spaces on periapical radiographs Vertical root fractures Mobility greater than Grade I (Miller's mobility index) Swelling or sinus tract associated with the treated tooth Presence of periodontal-endodontic lesions Teeth that could not be properly isolated with a dental dam Collection of less than 10 µL of blood from each site Conflicting clinical and radiographic findings preventing clear group assignment No bleeding from one or more canal orifices (possible partial necrosis)